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2. Please note that an application will not be processed without the following:

   Photo identification, SSN, $30 non-refundable connect fee to cover maintenance and administrative costs related to opening an account and a deposit (Owner - $125, Renter - $150); first and last pages of either the settlement statement or lease agreement (all names on ownership or lease documents will be listed on the account); the account will be billed as of the date on the aforementioned documents and may be subject to back bill charges; additional deposits are required if there is a separate meter for irrigation (sprinkler) purposes and is based on the size of meter; if there is a swimming pool at the service address, an additional $25 deposit is also required; we reserve the right to hold or delay service requests if service location was recently disconnected for non-payment.

   The Water Billing Office requires one working day notice to connect service. If same day service is requested, a fee of $25 must be paid. We must receive your application by 4 PM Monday through Thursday and by 12:30 PM on Fridays for same day service. Contact us at wbcs@pasadenatx.gov for any questions.

   I understand that I must contact Water Billing at (713) 475-5566 during business hours to pay the deposit and/or related fees. Services WILL NOT be initiated without these fees being paid.

   * Indicates a required field

4. Date to Start Service*
   Date to Start Service

   (Note: Water service connection can only be accommodated on weekdays. The City is unable to start water service on weekends or holidays.)

5. Please indicate if you are*
   -- Select One --OwnerRenterLandlordOther
7. Applicant First Name*
8. Applicant Middle Initial
9. Applicant Last Name*
11. Service Address*
13. City*
14. State*
15. Zip Code*
19. Driver’s License or ID#*
20. Date of Birth: *
    Date of Birth:
21. SSN:
23. Is applicant 65 or older?

    1. Yes
    2. No
24. Phone #:*
25. Alternate Phone #:
27. Email Address:*
29. Mailing Address (if different from Service Address):
33. Spouse/Other Occupant Name:
34. DL/ID#:
35. Spouse/Other Occupant SSN:
37. Date of Birth:
    Date of Birth:
38. Other Phone #:
42. Owner Name (if renting):
43. Owner Phone #:
45. Attachments

47. Copy of Driver's License with photo for each person listed on account.

49. 1st Driver's License File*
50. 2nd Driver's License File (If needed)
54. Settlement Statement/Lease (1st and last pages only)
55. Additional Files (If needed)

57. If you cannot upload, please send to wbcs@pasadenatx.gov

61. SERVICE WILL NOT BE INITIATED WITHOUT CONCURRENCE OF THE FOLLOWING:

    The City of Pasadena is responsible for protecting the drinking water supply from contamination or pollution which could result from improper system construction or configuration on the retail connection owner's side of the meter. The purpose of this service agreement is to notify each customer of the restrictions which are in place to provide this protection. The public water system enforces these restrictions to ensure the public health and welfare. Each retail customer must sign this agreement before the City of Pasadena will begin service. 

    RESTRICTIONS

    The following unacceptable practices are prohibited by State regulations: 

    No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by an air gap or an appropriate back flow prevention device. 

    No cross connection between the public drinking water supply and a private water system is permitted. 

    No connection that allows water to be returned to the public drinking water supply is permitted. 

    No pipe or pipe fitting that contains more than 8.0 percent lead may be used for the installation or repair of plumbing at any connection that provides water for human use. 

    No solder or flux, which contains more than 0.2 percent lead, can be used for the installation or repair of plumbing at any connection which provides water for human use.

    SERVICE AGREEMENT

    The following are the terms of the service agreement between the City of Pasadena and the Customer. The City will maintain a copy of this agreement as long as the customer and/or the premises are connected to the water system.

    The Customer shall allow his property to be inspected for possible cross-connections and other potential contamination hazards. These inspections shall be conducted by the City of Pasadena or its designated agent prior to initiating new water service; when there is reason to believe that cross-connections or other potential contamination hazards exist; or after any major changes to the private water distribution facilities. The inspections shall be conducted during the City of Pasadena’s normal business hours. 

    The City of Pasadena shall notify the Customer in writing of any cross-connection or other potential contamination hazard which has been identified during the initial inspection or the periodic re-inspection. 

    The Customer shall immediately remove or adequately isolate any potential cross-connections or other potential contamination hazards on his premises. 

    The Customer shall, at his expense, properly install, test, and maintain any backflow prevention device required by the City of Pasadena. Copies of all testing and maintenance records shall be provided to the City of Pasadena. 

63. ENFORCEMENT
65. Acknowledgement*

    1. I understand and agree

    If the customer fails to comply with the terms of the service agreement, the City of Pasadena shall, at its option, terminate service or properly install, test, and maintain an appropriate backflow prevention device at the service connection. Any expenses associated with the enforcement of this agreement shall be billed to the Customer. 

    I have read and agree to the terms listed in the above service agreement between myself and the City of Pasadena.

67. Acknowledgement*

    1. I understand and agree

    I understand that the bill is due and payable 18 days from the billing date. Failure to receive a bill does not waive penalty nor does it extend the due date.

69. Acknowledgement*

    1. I understand and agree

    I am aware that I don't need to be home to connect service, but if there is a leak, open pipe or open faucet (meter clearly indicates that water is running), the technician will turn the water off at the meter. There is a $20 charge for each subsequent trip to initiate service.

71. Acknowledgement*

    1. I understand and agree

    I understand that the City of Pasadena verifies the personal information provided on this application using various databases. If the City determines that I or other people shown as owners or listed on a lease owe past due balances to the City, I/we will be responsible for payment of those balances or can be transferred to this account.

73. Acknowledgement*

    1. I understand and agree

    I understand that water and sewer bills are based on the amount of water used. I also understand that I have a water meter that separates the city's water system from my private plumbing system and that I am responsible for any water that passes and registers on the meter.

75. IMPORTANT: Application will not be processed without the deposit and/or related fees being paid. Call 713.475.5566 during Water Billing's business hours.

Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit

* indicates a required field